@layout("/common/_form.html",{js:["/assets/expand/plugins/jquery/jquery-3.2.1.min.js","/assets/modular/sim/general/security/simRegister.js"]}){
<style>
    .layui-form-label{
        float:left;
        display:block;
        padding:9px 15px;
        width:170px;
        font-weight:400;
        line-height:20px;
        text-align:right
    }
    .layui-input-block {
        margin-left: 200px;
        min-height: 36px;
    }
</style>
<form class="layui-form" id="cardRegisterForm" lay-filter="cardRegisterForm" method="post" enctype="multipart/form-data">
    <div class="layui-fluid" style="padding-bottom: 75px;">
        <div class="layui-card">
            <div class="layui-card-body">
                <div class="layui-form-item layui-row">
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">MSISDN:<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input name="msisdn" type="text" class="layui-input" lay-verify="required|msisdnVer"/>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">ICCID:<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input name="iccid" type="text" class="layui-input" lay-verify="required|iccidVer"/>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">身份证姓名:<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input name="idName" type="text" class="layui-input" lay-verify="required|idnameVer"/>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">身份证号码:<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input name="idNo" type="text" class="layui-input" lay-verify="required|idnoVer"/>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">身份证地址:<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input name="idAddr" type="text" class="layui-input" lay-verify="required|idaddrVer"/>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">身份证生效时间:<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input id="idValiddate" name="idValiddate" type="text" class="layui-input" lay-verify="required"/>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">身份证失效时间:<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input id="idExpdate" name="idExpdate" type="text" class="layui-input" lay-verify="required"/>
                        </div>
                        <div class="layui-input-block" style="text-align: left">
                            <p>若长期有效，则失效时间为生效时间+100年</p>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">性别:<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <select id ="gender" name="gender" class="layui-select">
                                <option value="1">男</option>
                                <option value="0">女</option>
                            </select>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">民族:<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input id="nation" name="nation" type="text" class="layui-input" lay-verify="required|nationVer"/>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">出生日期:<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input id="birthday" name="birthday" type="text" class="layui-input" lay-verify="required"/>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">手机号码:<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input id="custPhoneNo" name="custPhoneNo" type="text" class="layui-input" lay-verify="required|phoneVer"/>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">身份证签证机关:<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input id="issuingAuthority" name="issuingAuthority" type="text" class="layui-input" lay-verify="required|issueVer"/>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">图片场景:<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <select id ="picType" name="picType" class="layui-select">
                                <option value="0">0：代表人像图片</option>
                            </select>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">用户现场人像图片:<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input type="file" name="userPic" id="importUserPic">
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">用户身份证芯片头像图片:<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input type="file" name="idCardPicFace" id="importCardPicFace">
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">用户身份证正面图片:<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input type="file" name="idCardPicFront" id="importCardPicFront">
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">用户身份证反面图片:<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input type="file" name="idCardPicBack" id="importCardPicBack">
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12" style="text-align: center">
                        <p>图片格式支持JPG、JPEG、PNG；同一卡号30分钟内不能通过此类接口重复办理业务；</p>
                    </div>
                </div>
            </div>
        </div>
    </div>
    <div class="form-group-bottom text-center">
        <button class="layui-btn" lay-filter="btnSubmit" lay-submit>&emsp;提交&emsp;</button>
        <button type="reset" class="layui-btn layui-btn-primary" ew-event="closeDialog">&emsp;取消&emsp;</button>
    </div>
</form>
@}
